Abstract

Over the last several decades, alcohol use, alcohol use disorder (AUD), and obesity, which are leading contributors to preventable death, have increased in prevalence. Research has shown that the three are related but much is still unclear. We examined associations between alcohol use, AUD, and weight status. Using National Health and Nutritional Examination Survey data, we examined associations between alcohol use and weight status, and between weight loss attempt and alcohol use. Among current drinkers, lower frequency of alcohol use and higher number of drinks beyond one drink per drinking day were independently associated with higher odds of class 1-3 obesity versus healthy weight in males and females; associations were stronger with higher classes of obesity. Females reporting weight loss attempt were more likely to be current drinkers and have more frequent heavy drinking. We examined whether associations between alcohol use and AUD differed by weight status using National Epidemiological Survey on Alcohol and Related Conditions-III data. Among males, interactions (P for all <.01) indicated that at the same average quantity of drinks per drinking day and frequency of heavy drinking, those with class 3 obesity had higher odds of AUD versus lower classes or no obesity. Among females, at the same frequency of any alcohol use, those with healthy weight had the highest odds of AUD, while females with class 3 obesity had the lowest odds of AUD (P<.001). We used Longitudinal Assessment of Bariatric Surgery-2 data to determine the sensitivity and specificity of potential thresholds of alcohol use for identifying alcohol-related problems in women post-Roux-en-Y-gastric bypass (RYGB). The sensitivity and specificity of an elevated Alcohol Use Disorder Identification Test-Consumption score, per standard scoring directions, were 76.4% (95%CI:73.2-79.7) and 81.6% (95%CI:80.2-83.0), respectively. Considering associations between alcohol use, AUD, and weight status is critical to public health efforts to develop more effective prevention and treatment strategies for both diseases. We provide evidence that females trying to lose weight do not follow clinical weight loss guidelines and that AUD screening may be improved if modified for populations with different gender, weight status, and bariatric surgery history.